Alcohol use problems range from occasional problem drinking to alcohol misuse to alcoholism. Alcoholism, also known as alcohol dependence, is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is often progressive and fatal.

The NIAAA defines risky drinking of "standard drinks," with one standard drink equal to about 12 ounces of typical American beer, 5 ounces of wine, or 1.5 ounces of hard liquor. These figures are based on "typical" (mass market) forms of beer and wine; particularly for beer, many specialty beers may contain up to twice the amount of alcohol as a mass market beer does. For wine, the alcohol content is more constant, but wine coolers often contain less alcohol and some types of wine, such as zinfandels and port, may contain twice the average amount of alcohol. For men, 4 or more drinks a day or 14 or more a week within the last year is considered risky, while for women it is 3 or more a day or 7 or more a week.

While consuming alcohol is, by definition, necessary to develop alcoholism, the use of alcohol by itself does not predict the development of alcoholism. The quantity, frequency, and regularity of alcohol consumption required to develop alcoholism varies greatly from person to person. People's response to alcohol may be affected by their size, age, general state of health, and by the medications they are taking. In some, fewer drinks can still cause health problems. Since there is no known "safe" alcohol level for pregnant women, the Surgeon General advises women who are, or are planning to be, pregnant to abstain from drinking.

Tolerance: the need to drink greater amounts of alcohol to get the same experience as achieved initially

Craving: a strong need, or urge, to drink

Loss of control: not being able to stop drinking once drinking has begun

According to the U.S. Centers for Disease Control and Prevention (CDC), alcohol misuse is a pattern of drinking that results in particular problematic situations, such as failure to fulfill major work, school, or home duties or having recurring alcohol-related legal problems, such as arrests for driving under the influence of alcohol.

According to the National Survey on Drug Use and Health, approximately 15 million American adults misuse alcohol or are alcohol dependent. In the United States, nearly 20% of patients treated in general medical practices report drinking at levels considered "risky" or "hazardous." According to NIAAA, less than 10% of patients with alcohol use disorder receive treatment.

Long-term health risks

According to the CDC, long-term, excessive alcohol use can lead to the development of several medical and social problems. These include:

Having hepatitis C virus (HCV) and using alcohol reduces liver function and can interfere with medications taken to treat the HCV. In addition, if you have another form of liver disease (including hepatitis C), alcohol can make the disease more likely to progress to cirrhosis and cause death.

Women tend to be more sensitive to the effects of alcohol and may develop alcohol-related health problems sooner and after consuming less alcohol than men do. Alcohol use in pregnant women can lead to miscarriage, stillbirth, premature birth, low birth weight, and other problems in the baby, such as abnormal facial features, malformation of organs (such as the brain and heart), growth deficits, and hearing and vision problems. Brain damage due to a mother's alcohol use may result in behavioral problems, speech and language delays, and learning disabilities, according to the March of Dimes.

Alcohol misuse and dependence are primarily diagnosed through the use of clinical screening surveys. Several hundred such surveys exist, and they vary in the number and nature of questions they ask. Some of the more common scientifically-validated questionnaires include the Michigan Alcohol Screening Test (MAST), a shorter version called the Brief MAST, the Alcohol Use Disorders Identification Test (AUDIT), and a commonly employed, quick survey called the CAGE questionnaire. These surveys ask a range of questions about frequency of drinking, problems that result, and ability to stop.

There are no definitive laboratory tests that can be used to identify alcoholism. However, certain tests may help detect chronic and/or relapse in alcohol drinking in those who deny it and help evaluate organ damage. According to the Substance Abuse and Mental Health Administration, these include:

Mean corpuscular volume (MCV), which measures the size of red blood cells; usually measured as part of a complete blood count (CBC) test; the MCV may increase over time in those who are heavy drinkers but may also be affected by many other conditions.

Like many chronic diseases, alcoholism cannot be cured; however, effective treatment is available to help individuals who suffer from alcoholism remain sober. Treatment usually consists primarily of group therapy, one or more types of counseling, and alcohol education. Participants must acknowledge that they have a drinking problem and have a strong desire to stop drinking. Once the decision has been made, they may check into a treatment center for a brief period of time to rehabilitate as they stop drinking. The treatment center (and/or doctor) counsels patients, gives them support, and helps them get through their initial symptoms and safely withdraw from the alcohol. In some cases, short-term medications such as benzodiazepines (Valium or similar drugs) are used to help alleviate some of the symptoms of alcohol dependence.

There are three oral medications that have been FDA-approved to help people remain sober: disulfiram, naltrexone, and acamprosate. They are prescribed for those who have indicated their intention to abstain from alcohol but require some reinforcement. Disulfiram causes unpleasant symptoms such as nausea, vomiting, and flushing with any amount of drinking. Naltrexone limits the cravings a person may get from drinking but can cause severe withdrawal symptoms in people who are also dependent on opiates. Acamprosate helps reduce the craving for alcohol. An injectable, long-acting form of naltrexone is also available. All of these medications are meant to be used in combination with counseling.

Just as there is no one test for screening or diagnosing alcoholism, there is not one single therapy or medication that definitively treats alcoholism in all those affected. Like many chronic diseases, alcohol dependence is not an easy condition to resolve, and many people will relapse into drinking several times before gaining lasting sobriety. Some of the damage done to the liver and to other organs while drinking may resolve, while some may be permanent. Patients and their doctors will need to work together over the years to maintain sobriety and to address any complications that arise from alcohol damage.

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.

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(June 2006) Quick Reference Instrument Guide. National Instittue on Alcohol Abuse and Alcoholism. Available online at https://pubs.niaaa.nih.gov/publications/AssessingAlcohol/quickref.htm. Accessed on 5/3/17.

(2005 February 21). March of Dimes, No "Safe" Level of Alcohol Use During Pregnancy, March of Dimes Warns, Thanks Surgeon General for Urging Pregnant Women to Abstain from Alcohol. Available online at http://www.marchofdimes.com/aboutus/14458_15138.asp.

NIAAA. FAQs for the General Public. Available online through http://www.niaaa.nih.gov. Accessed August 2009.

National Institute on Alcohol Abuse and Alcoholism. Alcohol Use Disorders. Available online at http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders. Accessed March 7, 2013.

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National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert. Available online at http://pubs.niaaa.nih.gov/publications/aa08.htm. Published April 1990. Accessed March 12, 2013.

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